MEDICARE: UNIVERSAL COMMUNITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1295318319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	2801 S SAN PEDRO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-2023
Country	:	US
Telephone Number	:	323-233-3100
Fax Number	:	323-233-4100

Provider Business Practice Location Address
First Line	:	4527 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1116
Country	:	US
Telephone Number	:	323-233-3100
Fax Number	:	323-233-4100

Authorized Official
Title or Position	:	CEO
Name	:	EDGAR ALEXANDER CHAVEZ
Credential	:	MD
Telephone Number	:	323-233-3100

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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